The invention relates in general to orthopedic guides, and more particularly to an apparatus for aiding a person in donning an ankle foot orthosis.
An Ankle Foot Orthosis (hereinafter an AFO) is a medical device that assists patients who have lost at least partial control over the angle in which they can maintain their foot respective to their leg. Often, as a result of a stroke or some other medical conditions, those patients"" foot can not be raised to avoid obstacles. This may be dangerous, since the patient can trip. The AFO thus holds the foot at a predetermined angle, usually around 90 degrees, to the leg. Common AFO""s hold the patient""s calf and foot, and inserted into a regular shoe. The shoe is then worn over the AFO and thus the AFO is invisible. However donning such an AFO is a hard task for many patients due to the reduced motor control, difficulty in bending down, reduced coordination and other physical limitations stemming from their condition.
The AFO generally has a foot portion and a calf portion, at about 90 degrees to each other. The foot portion is inserted into the shoe, and the patient puts his/her leg into the shoe in the usual manner. A band or other securing means is used to secure the calf portion to the patient""s calf. Thus the patient""s foot gains rigidity to avoid dropping the foot at an angle greater than 90 degrees.
The problem of donning an AFO is known, and several inventions have been made to assist patients in donning them. In U.S. Pat. No. 4,683,876, Changras teaches an orthopedic guide having a backing slab and two parallel sidewalls secured parallel thereto to define a channel in which an AFO is placed within a shoe. The shoe is then placed in the channel, so that the AFO calf portion rests against the backing slab. The patient grabs a handle attached to the device and slides his foot along the AFO using it to guide his/her foot into the shoe.
The ""876 patent suffers from several disadvantages. It forces the patient to hold onto the orthopedic guide while performing the task of sliding the foot down the guide. The device is placed vertically, so it requires the patients"" leg to follow such a vertical movement. This is often inconvenient and difficult, especially while attempting to hold the device steady. The Changras device is also unstable since the backing plate and extensions to the side walls are placed high on the device causing it to have a high center of gravity and making it prone to falling over on its back or side. The device also requires the use of a strap in order to stabilize the shoe in place. For a patient with motor control problem, this is often a difficult task to achieve.
U.S. Pat. No. 3,012,702 to Van Der Vliet describes a shoehorn having a flat base to hold the shoe in place. A flexible portion positioned above the rear portion of the shoe is adapted to engage the heel of a foot being inserted into the shoe. This device again does not solve the problem of easily locating the device with the shoe at a comfortable angle for placing the patient""s foot into the shoe, and the flexible portion is likely to interfere with an AFO inserted into the shoe. Additionally, while using a shoehorn, the AFO will tend to turn and fail to maintain alignment with the shoe. Votino et al. in U.S. Pat. No. 5,972,573 disclose another shoehorn directed specifically to the physically handicapped. This device as well is likely to interfere with a shoe having an AFO attached thereto, and is large and bulky in comparison to the current invention.
Different gripper devices are contemplated in the likes of U.S. Pat. Nos. 5,974,701 to Busch and 5,687,889 to Liden. Those devices fall short of the desired results as they require precise manipulation of a gripper arm or hook, placed at the end of a long stick, all by a patient often suffering severe motor dysfunction.
There is therefore a clear and unsolved need for a stable, simple to operate device to assist a patient in donning an AFO, without requiring uncomfortable or hard to maintain body positions. The current invention aims to provide such a device.
In this application, the word cylindrical is not limited to a circular cylinder or shape, but should be construed as the surface traced by a straight line moving parallel to a fixed straight line and intersecting a fixed planar curve. Unless otherwise indicated, the direction extending along the foot portion away from the joint is commonly referred to as forward and the direction extending along the calf portion away from the joint is referred to as up. Correspondingly, back and down directions are construed as opposite to said forward and up directions respectively. Unless otherwise indicated, the word xe2x80x98devicexe2x80x99 relates to one or more implementations of the current invention.
It is an object of the present invention to solve the problem and shortcoming described above and to provide an AFO donning device constructed of an L-shaped channel where the vertical leg of the L shaped channel forms a channel-like calf portion, and the horizontal leg of the L shaped channel forms a channel-like-foot portion. The connecting point of the foot portion and the calf portion is referred to as a joint in this application. Surfaces and volumes generally formed within the volume bound by the smaller of the two angles defined by the foot portion and the calf portion are referred to as being inside, and conversely surfaces and volumes defined by the larger of the two angles are referred to as being outside, the L-shape.
A rocker is provided on the outer or rear side of the L-shaped channel, at least near the joint. The rocker extends rearwardly from the back side of the joint area, and has a convexly arcuate rail 25, acting as a ground engaging surface. The rail is contoured to act as a cam to allow substantially smooth rotation of the L-shaped channel into an inclined position when tilted.
The foot portion of the L-shaped channel is weighted, preferably at its forward portion away from the joint. The weighting may be done by properly distributing the mass of the device, using different materials, adding a weight along the foot portion, preferably at a point distal to the joint, or by other known methods. The weight distribution should be sufficient so that when the device is positioned on the rail, the weight of the foot portion will bias and urge the device to an upright rest position in which the calf portion is in a substantially vertical orientation, and the foot portion is in a substantially horizontal orientation. Optionally, in resting position, the device should lean slightly backward to compensate for the weight of a shoe and an AFO placed is the L-shaped channel, or provide a more comfortable angle for positioning a patient""s leg.
Preferably, an extended rail extends upwardly in continuation to the aforesaid rail, or integrated therewith. In the preferred implementation, the extended rail is formed as an integral extension of the rocker, and extends upward and backward of the joint area to form a rocker extension. By adapting the extended rail cylindrical shape to increase the distance of the joint from the ground as the device is tilted, an eccentric cam is created. The eccentric cam further increases the moment of the added weight of the foot portion and thus further biases the propensity of the device to return to an upright rest position.
Optionally, the rocker may depend forwardly and downwardly from the joint area towards the distal end 15 of the foot portion to form a resting rail 30. Such a resting rail is helpful for example if an increased height or a specific rocking motion is desired.
To further enhance the invention, a shoe tongue retainer is disclosed. The shoe tongue retainer generally comprises a short C-shaped clip 202, where one end of the clip is bent or formed to roughly conform to the shoe toe, and the other end is formed as a hook to engage and maintain the tongue of a shoe at a forwardly folded position. This tongue retainer is used to increase the shoe opening during foot insertion, and may be easily removed when not needed, as described below.